Zinner syndrome unveiled: Ectopic ureter and seminal vesicle cyst leading to urinary dysfunction: A case report

Abstract

Zinner syndrome (ZS) is a rare congenital urological condition characterized by a triad of ipsilateral seminal vesicle cysts, unilateral renal agenesis, and ejaculatory duct obstruction, first described in 1914. This case report details the presentation and management of a 27-year-old male diagnosed with ZS following a 2-month history of urinary frequency, hesitancy, dysuria, and painful ejaculation. Physical examination revealed a left lower abdominal mass, and imaging confirmed the classic findings of ZS, including unilateral renal agenesis, an enlarged seminal vesicle cyst, and an ectopic ureter. Conservative treatment with tamsulosin initially improved symptoms, but due to the cyst's large size and the risk of complications, laparoscopic excision was recommended for definitive management. ZS is often diagnosed late due to nonspecific symptoms, with an average diagnosis age of 29.35 years. MRI is the gold standard for diagnosis, revealing seminal vesicle cysts, renal agenesis, and ejaculatory duct obstruction. Conservative management is reserved for asymptomatic cases, while symptomatic patients benefit from surgical intervention. This case emphasizes the importance of timely imaging, particularly in patients with nonspecific lower urinary tract symptoms, and highlights the role of tamsulosin as an effective interim therapy before definitive surgical treatment. The case underscores the need for clear diagnostic criteria and treatment pathways to improve outcomes in this rare condition, which can lead to infertility if not managed appropriately.